The ACTION, EUROPA and IONA trials: similarities, differences, outcomes and expected outcome

The ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS) study is the largest ever performed randomised trial of an anti-anginal drug in patients with chronic stable angina. Its aim is to assess the effect of nifedipine GITS 60 mg versus placebo on standard therapy for coronary artery disease on event-free survival; its composite end point includes death from any cause, acute myocardial infarction, hospitalisation for overt heart failure, emergency coronary angiography, disabling stroke and procedures for peripheral revascularisation.
ACTION is one in a series of trials assessing drug effects in chronic stable coronary artery disease. The IONA (Impact Of Nicorandil in Angina) and EUROPA (EURopean trial On reduction of cardiac events with Perindopril in stable coronary artery disease) studies demonstrated that the K-ATP channel activator nicorandil and the angiotensin-converting enzyme inhibitor perindopril reduced the primary composite end point for cardiac events by 17% and 20%, respectively.
Nifedipine GITS is an effective antihypertensive and anti-anginal drug. In the INSIGHT trial, nifedipine GITS 30/60 mg demonstrated comparable outcomes to a diuretic combination therapy with significant effects on intermediate end points. ENCORE I (Evaluation of Nifedipine and Cerivastatin on Recovery of coronary Endothelial function) demonstrated that nifedipine GITS 30/60 mg positively affected the pathophysiology of coronary artery disease. We therefore anticipate that nifedipine will affect blood pressure, anginal symptoms and resulting complications, and the coronary atherosclerotic process in those patients randomised to receive this agent in the ACTION study.